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Sunday, July 10, 2011

not my plans . . .

"Tis the season for transition, closure, goodbyes and launchings. And with that comes a certain level of disquiet, unexpected since we're still in the entry phase of life, and no one is graduating in our family. I've had a hard time putting my finger on the heartache that has settled more and more heavily upon the week . . .

For one thing, Mardi was gone, which made me realize just how much of our survival rests on the space she creates in my life at least, which of course spills over into the rest of the family in details like actually having enough food cooked . . After a month of job-sharing, going back to solo full-time-plus was harder than I thought. All the interns did their quarterly transition to new services this week too, which makes the medical care temporarily more challenging as people orient and adjust from 75 kg waling-talking patients to 1 kg fragile mysteries. At 2 am on my call night I was summoned to break the news to a mother that her baby was dead, and since it was a baby who had not previously been thought to be sick and was found cold and lifeless, it took hours of investigating just what went wrong, as well as explanation and comfort for the oddly stoic mother. Out of that sorrow came some good meetings and ideas about documentation and responsibility, so that if this was at all preventable we'll have a better shot at doing so the next time. And another afternoon just when everything seemed quite calm in nursery, a nurse came running in with something in a sheet, which turned out to be a 750 gram 26-week girl who had been delivered in the grass outside. That led to immediate action, resuscitating, warming, breathing, testing, getting her into an incubator and on support. And the whole process was complicated by a sullen quietly distressed non-communicative mother who it turned out had hidden her pregnancy from her parents, and "happened" to be hanging around the hospital because another child in the family was being seen in a clinic for another problem. Between the social complications of negotiating disclosure to the mother's father, and trying to keep the baby breathing, it was a long afternoon, and the tiny baby never really had much drive for life. So after some hours I was left with the excruciating task of deciding that we had done all we could do, gathering the medical team to discuss options, getting the mother and her father in to see the baby once, and then allowing her to die. That is the awful responsibility that I find very very draining.

There were some highlights in the nursery too, though, a much-valued only baby Shunetra who has hovered on the brink of death for two weeks with meningitis, sepsis, prematurity, feeding issues, respiratory distress, a heart lesion, you name it, gradually improved. A baby whose heroic mother did every-one-hour-feedings for weeks came back a week after discharge having gained great weight and looking so cute and normal. A malnourished baby whose intestinal obstruction was surgically corrected went home miraculously well. I had some time for teaching, both bedside and in a weekly lecture, which I enjoy. But I missed sharing the weight of responsibility.

Then there is the social craziness of this week. One day I came home and found we had four college kids from four countries for lunch--fun to hear them compare Korea, Japan, Scotland, and the USA. We have one girl from Luke's class staying with us for "alumnae weekend" and others drift in and out for movies and meals. Though we're not nearly as involved as many families here, the Netherlands and Australia have also been represented at meals this week, not to mention everyone's African countries (Rwanda, South Sudan, Kenya, Uganda). There are concerts and games and special events. The three younger kids were in exams, so that added a level of stress and a variation to the schedule too. Luke is slowly recovering from a couple of motorcycle mishaps, which have left him bruised and scraped, and rather uncomfortable and discouraged. Rugby semi-finals were yesterday too, a well-fought match against the same school that beat us badly a week ago, we came close to a tie, but disappointingly it did not happen. In the midst of band and choir and teams and returning alumnae and conversations, some of the disquiet comes from hearing kids process the school, the tension between exclusion and inclusion, the lines between who is in and who is out.

Somewhere in the middle of exams and visitors and work and patients, I totally forgot a staff meeting, and slipped even further behind in any progress on a list of things to be addressed in the newly delineated department of pediatrics (which I am supposed to be clinical director of, by virtue of being a decade older than everyone else I think). Every day I think i'll get time to make progress on details for our Africa field retreat only a month away, but another day goes by.

Besides the sapping of energy from hard decisions and lots going on . . . a large part of the crushing heart-level weariness I realize comes from a couple of specific prayers unanswered. Or at least not the answers I wanted. One prayer was for our neighbors to receive a US visa to bring their legally-adopted-Kenyan 2 1/2 year old to the States as the family completes their service in Kijabe after over 25 years, and accompanies one of their older children back to university. The US Embassy denied the visa, in spite of many appeals and letters and a reasonable legal interpretation of the statutes, and I feel their pain as they must split their family. Of all the dangers our embassy must protect American from, allowing a brilliant healthy darling loved daughter to travel with her parents does not seem to be one of them to me. Then I had prayed a couple of specific things for one of our kids, and yet watched them experience rejection, which really hurt at a deep level.

And sometimes it seems like most of the people we have gotten to know in the last six months . . are leaving within two weeks.

So today the message of Jesus in all of this unexpected unease, came through seniors giving testimony, and through the choir's excellent drama on the book of Job, the reminder once again that God's plan can not be thwarted by apparent rejection or loss. This week did not, in many seemingly important respects, go the way I hoped it would. Which is usually the context for God's work. Jesus was despised by men and acquainted with grief; He did not live a life of peace or success. He allows disappointment and injuries and goodbyes and failures for His own mysterious purposes, which we declare by faith are good, even if painful. Amen.

Our Mission

who we are

paradox:
1. something that combines contradictory features or qualities.
Life in Africa is full of contradictions - the beauty and pain; the abundance and the poverty; the joy and the sorrow.
Our lives, too...dying that we might live; strong in our weakness; sinners yet saints.
2. a "pair of docs"